CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Mc Donough District Hospital

Billing Code: 99213 (CPT)

The BaseRate · fair price high confidence
A fair price for this
$64
about 0.7× the $95 Medicare rate · typically $54–$87
modeled estimate · not a bill or quote
What this hospital charges insurers
$63
About the fair price
about $1 under the fair price · 0.7× Medicare
Medicare pays $95 Fair price $64 This hospital $63 Cash price $101 Hospital's list price $168

How we calculate the fair BaseRate →

How this hospital compares to other IL hospitals

Highest price of the 9 IL hospitals we have prices for — worth calling around.

Cheapest $48 Priciest $63

Black dot = this hospital, among the 9 IL hospitals with a price for this procedure. Full list below.

A fair price for a Office visit, established patient (20-29 min) is about $64 (about 0.7× the $95 Medicare rate). Mc Donough District Hospital charges insurers about $63, or about $101 in cash — about the fair price. Located in Macomb, IL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $59 - $270 62%
Blue Cross Blue Shieldmajor $85 - $300 89%
Aetnamajor $20 - $300 21%
Humanamajor $63 - $270 66%
HealthLink $76 - $282 80%
Meridian $63 - $86 66%
Molina $63 - $300 66%
+ 9 smaller / regional plans $38 - $300
Government programs also on file: Medicare, Medicaid.
Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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Facility Profile & Credentials

  • Address: 525 East Grant Street, Macomb, IL 61455
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals